ArticleDiabetes care2013
Cancer incidence among those initiating insulin therapy with glargine versus human NPH insulin.
Article in Diabetes care, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Treatment with insulin (analogues) and breast cancer risk in diabetics; a systematic review and meta-analysis of in vitro, animal and human evidence.Breast cancer research : BCR · 2015Pooled it
- Association Between Melatonin Use and Cataract Risk: A Target Trial Emulation Retrospective Cohort Study.Antioxidants (Basel, Switzerland) · 2025Article
- Cancer biology in diabetes update: Focusing on antidiabetic drugs.Journal of diabetes investigation · 2024Review
- A Road Map for Peer Review of Real-World Evidence Studies on Safety and Effectiveness of Treatments.Diabetes care · 2023Review
- Core concepts in pharmacoepidemiology: Confounding by indication and the role of active comparators.Pharmacoepidemiology and drug safety · 2022Review
- Real-world evidence: the devil is in the detail.Diabetologia · 2020Review
- The Use of Long-Acting Insulin Analogs and the Risk of Colorectal Cancer Among Patients with Type 2 Diabetes: A Population-Based Cohort Study.Drug safety · 2020Article
- Methodological considerations when analysing and interpreting real-world data.Rheumatology (Oxford, England) · 2020Article
- Incretin-Based Therapies and Diabetic Retinopathy: Real-World Evidence in Older U.S. Adults.Diabetes care · 2018Article
- The importance and implications of comparator selection in pharmacoepidemiologic research.Current epidemiology reports · 2018Article
- Long-term exposure to insulin and volumetric mammographic density: observational and genetic associations in the Karma study.Breast cancer research : BCR · 2018Observational
- Effects of insulin and analogues on carcinogen-induced mammary tumours in high-fat-fed rats.Endocrine connections · 2018Article
- Considerations for Pharmacoepidemiological Studies of Drug-Cancer Associations.Basic & clinical pharmacology & toxicology · 2018Review
- Genome-Wide Analyses Identify Filamin-A As a Novel Downstream Target for Insulin and IGF1 Action.Frontiers in endocrinology · 2018Article
- Cancer risk among insulin users: comparing analogues with human insulin in the CARING five-country cohort study.Diabetologia · 2017Article
- Comparative Effect of Initiating Metformin Versus Sulfonylureas on Breast Cancer Risk in Older Women.Epidemiology (Cambridge, Mass.) · 2017Article
- Utilization of fetal fibronectin testing and pregnancy outcomes among women with symptoms of preterm labor.ClinicoEconomics and outcomes research : CEOR · 2017Article
- Effect of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on colorectal cancer incidence and its precursors.European journal of clinical pharmacology · 2016Article
- Insulin glargine use and breast cancer risk: Associations with cumulative exposure.Acta oncologica (Stockholm, Sweden) · 2016Article
- The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application.Current epidemiology reports · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
Abstract
objectiveTo add to the evidence on comparative long-term effects of insulin analog glargine versus human NPH insulin on the risk for cancer. RESEARCH DESIGN AND
methodsWe identified cohorts of initiators of glargine and human NPH without an insulin prescription during the prior 19 months among patients covered by the Inovalon Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry) between January 2003 and December 2010. Patients were required to have a second prescription of the same insulin within 180 days and to be free of cancer. We balanced cohorts on risk factors for cancer outcomes based on comorbidities, comedication, and health care use during the prior 12 months using inverse probability of treatment weighting. Incident cancer was defined as having two claims for cancer (any cancer) or the same cancer (breast, prostate, colon) within 2 months. We estimated adjusted hazard ratios (HRs) and their 95% CI using weighted Cox models censoring for stopping, switching, or augmenting insulin treatment, end of enrollment, and mortality.
resultsMore patients initiated glargine (43,306) than NPH (9,147). Initiators of glargine (NPH) were followed for 1.2 (1.1) years and 50,548 (10,011) person-years; 993 (178) developed cancer. The overall HR was 1.12 (95% CI 0.95-1.32). Results were consistent for breast cancer, prostate cancer, and colon cancer; various durations of treatment; and sensitivity analyses.
conclusionsPatients initiating insulin glargine rather than NPH do not seem to be at an increased risk for cancer. While our study contributes significantly to our evidence base for long-term effects, this evidence is very limited mainly based on actual dynamics in insulin prescribing.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.